Shared Care in Monitoring Stable Glaucoma Patients: A Randomized Controlled Trial.

PURPOSE: Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual. PATIENTS AND METHODS: This randomized controlled trial included stable glaucoma patients and patients at risk for developing glaucoma. Patients in the Usual Care group (n=410) were seen by glaucoma specialists. In the glaucoma follow-up unit group (n=405), patients visited the glaucoma follow-up unit twice followed by a visit to a glaucoma specialist. The main outcome measures were: compliance to the working protocol by glaucoma follow-up unit employees; difference in intraocular pressure between baseline and at ≥18 months; and patient satisfaction. RESULTS: Glaucoma follow-up unit employees closely adhered to the working protocol for the measurement of intraocular pressure, visual acuity and GDx (≥97.5% of all visits). Humphrey Field Analyzer examinations were not performed as frequently as prescribed by the working protocol, but more often than in the Usual Care group. In a small minority of patients that required back-referral, the protocol was disregarded, notably when criteria were only slightly exceeded. There was no statistically significant difference in changes in intraocular pressure between the 2 treatment groups (P=0.854). Patients were slightly more satisfied with the glaucoma follow-up unit employees than with the glaucoma specialists (scores: 8.56 vs. 8.40; P=0.006). CONCLUSIONS: In general, the hospital-based shared care glaucoma follow-up closely observed its working protocol and patients preferred it slightly over the usual care provided by medical doctors. The glaucoma follow-up unit operated satisfactorily and might serve as a model for shared care strategies elsewhere.

Beijing Eye Public Health Care Project.

PURPOSE: The Beijing Eye Public Health Care Project was designed to screen all elderly subjects (age 55-85 years) of the rural region of Greater Beijing. It was developed as a preparatory step for a telemedicine-based public health care system in ophthalmology in China. DESIGN: Population-based public health care project. PARTICIPANTS: Elderly subjects (age 55-85 years) of the rural region of Greater Beijing. METHODS: Project participants were visited, interviewed, and examined by 2500 high school graduates trained as ophthalmic technicians. If visual acuity was <0.30, subjects were referred to primary health care centers where ocular photographs were taken. Using telemedicine, the photographs were transmitted to a reading center and causes for visual impairment were diagnosed. MAIN OUTCOME MEASURES: Practicability of a mass screening system in ophthalmology; prevalence of visual impairment and causes for it. RESULTS: Out of 692 323 eligible inhabitants, 562 788 (81.3%) subjects participated. Visual impairment in ≥1 eye was detected in 54 155 (9.62%) subjects, and among them, 30 164 (5.36%) subjects had bilateral visual impairment. Ocular fundus photographs were taken for 37 281 subjects. Cause for visual impairment was cataract in 19 163 (3.41%) of all screened subjects, glaucoma in 1606 (0.29%) subjects, diabetic retinopathy in 905 (0.16%) subjects, other macular diseases in 2700 (0.48%) subjects, pterygium in 1381 (0.25%) subjects, and corneal leukoma in 283 (0.05%) subjects. For 5853 (1.04%) subjects, a diagnosis of premature or mature cataract was made showing the urgent need of cataract surgery. After cataract surgery, visual acuity was ≥0.30 in 1464 (91.7%) of 1596 postoperatively reexamined subjects. CONCLUSIONS: Using a telemedicine approach, the Beijing Eye Public Health Care Project developed, applied and tested an infrastructure for ophthalmic mass screening of >500 000 elderly inhabitants with a response rate of >80%. Beside cataract, retinal diseases including diabetic retinopathy and glaucoma were major causes for visual impairment. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.